VOLUME XII ISSUE 3
Live Life Better
ST. CLAIR MEDICAL SERVICES: EXPANDING UROLOGIC CARE
UROLOGIC HEALTH
Enhancing Urologic St. Clair Medical Services Expands Urologic Care Two of the region’s top urologic practices have come together after the Center for Urologic Care joined St. Clair Medical Services. It’s a partnership that promises to expand the availability of state-of-the-art urologic care in the area. By joining Kevin P. Bordeau, M.D., in St. Clair Medical Services, the four physicians who Jay A. Lutins, M.D.
comprise the Center for Urologic Care have brought together five exceptionally well-qualified, experienced urologic surgeons in a practice with a whole-person approach to comprehensive urologic health.
“
OUR TRADEMARKED MOTTO IS ‘LIVE LIFE BETTER’.
JAY A. LUTINS, M.D.
”
JAY A. LUTINS, M.D. Dr. Lutins specializes in urology. He earned his medical degree at the Medical College of Virginia, Richmond, and completed a residency at UPMC. Dr. Lutins is board-certified in urology. He practices with St. Clair Medical Services. To contact Dr. Lutins, please call 412.572.6194.
About The Cover: Pictured in an operating room at St. Clair Hospital are St. Clair Medical Services urologists, left to right, Shailen S. Sehgal, M.D., Kevin P. Bordeau, M.D., Arthur D. Thomas, M.D., Jay A. Lutins, M.D. and David O. Hepps, M.D. 2 I HouseCall I Volume XII Issue 3
Health
“We’re delighted to team with Dr. Bordeau,” says Jay A. Lutins, M.D.,
who served as senior partner at the Center for Urologic Care. “Kevin is an exceptionally skilled urologic surgeon and a great colleague. Moreover, we’re excited at what the partnership does for the community. Together we can bring greater flexibility, decreased wait times for appointments and exams, and more comprehensive clinical services. We’ll treat every possible urologic problem or emergency – the entire gamut – and do so in a timely fashion – usually within a week.” Dr. Bordeau is equally enthused about the union. “Dr. Lutins and his colleagues – David O. Hepps, M.D.; Shailen S. Sehgal, M.D.; and Arthur D. Thomas, M.D. – are an outstanding group, committed to excellence in urologic care. I’m excited about the addition of my colleagues from the Center for Urologic Care. I know them all very well and they are extremely
Kevin P. Bordeau, M.D.
talented and are expanding our ability to care for most urologic issues right here in the South Hills. Their addition brings additional expertise in erectile dysfunction and prosthetic urology, and gives us all a greater capacity to expand our services in urologic oncology and stones disease.” Urology requires a broad range of competencies to treat a great variety of conditions and diseases. They are surgeons first, but their field demands that they be knowledgeable in internal medicine, gynecology, oncology, nephrology and other medical disciplines. Urologists treat the urinary tract (kidneys, ureters and bladder) in males and females, and treat problems of the male reproductive organs. There are multiple subspecialties within urology, including pediatric urology; urologic oncology; neuro-urology; and treatment of male sexual dysfunction. Common urologic conditions include benign prostatic hypertrophy, bladder cancer, prostate cancer, erectile dysfunction, infertility, kidney stones, kidney cancer, prostatitis, urinary incontinence, urinary tract infections, and overactive bladder. Continued on Page 4
KEVIN P. BORDEAU, M.D. Dr. Bordeau specializes in urology. He earned his medical degree at Tufts University, Medford, Mass., and completed a residency at Eastern Virginia Medical School, Norfolk. Dr. Bordeau is board-certified in urology. He practices with St. Clair Medical Services. To contact Dr. Bordeau, please call 412.572.6194.
Volume XII Issue 3 I HouseCall I 3
UROLOGIC HEALTH Continued from Page 3
Urologic conditions and diseases can make life miserable for
profound negative impact on daily living. Incontinence makes people
those who are afflicted. Even when these conditions are not life-
feel diminished – no one wants to have to wear an adult diaper.
threatening, they can be life-changing: overactive bladder, stress
It feels demeaning. Urologic health is important and is a very personal
incontinence, erectile dysfunction and other conditions can wreak
matter.” The urologic surgeons at the Center for Urologic Care
havoc with everyday life, limiting a person’s ability to function with
understand the complexity of this, and for them the standard of care
comfort and freedom. Furthermore, these conditions often have an
goes far beyond prescribing medication or correcting problems in the
emotional impact – they may reduce one’s self esteem and sense of
OR: they improve lives and restore self-esteem.
self-efficacy, and may lead to social isolation, shame and depression. “These are quality of life issues,” says Dr. Lutins. “They often have a
“Our trademarked motto is ‘Live Life Better.’ We can restore your peace of mind and your quality of life. We are quite adept at improving urologic health and we welcome everybody – we treat all patients over 18.” Dr. Lutins says most people will need to see a urologist at some point in their lives. “Urologic conditions are common, but they are not normal. No one should accept incontinence as an inevitable aspect of aging. No one should suffer needlessly. There is an excellent chance that, whatever your problem is, we can help you.” Many urologic conditions can be successfully treated in the office, with medication or minor procedures. Urologic surgeons also perform a wide range of minimally invasive procedures to treat many urologic conditions. They also perform major, complex procedures and were among the first surgical specialties to make wide use of roboticassisted surgery to treat many conditions, including prostate cancer. Prostate cancer is one of the most common cancers; one in nine
David O. Hepps, M.D.
men will be diagnosed with it in their lifetimes. Frequently, explains Dr. Bordeau, it is a slow-growing cancer that can be monitored with what urologists call “active surveillance” – regular screening and examinations to make certain that the cancer has not spread or become more aggressive. “When we do prostate surgery, we develop a genuine relationship with the patient,” Dr. Bordeau says. “We offer a lot of support and preparation, including pre-surgery pelvic floor exercises. Our PA (physician assistant) meets with every patient and they talk about every aspect of the surgery. The response to the surgery is very individualized, but whatever happens, if the patient has pain or a problem, I will be there. I tailor the process to their needs
DAVID O. HEPPS, M.D. Dr. Hepps specializes in urology. He earned his medical degree at Jefferson Medical College, Philadelphia, completed a residency at University of Illinois at Chicago, and a fellowship at the University of Miami. Dr. Hepps is board-certified in urology. He practices with St. Clair Medical Services. To contact Dr. Hepps, please call 412.572.6194.
4 I HouseCall I Volume XII Issue 3
and I can tell when they need an extra day in the hospital, or they need to get home earlier. It’s a matter of trust, and trust between a patient and physician leads to better care. My Dad died at the age of 50 and I look at each patient as if they are a family member. Every patient may be somebody’s beloved father.” The physicians and staff of the Center for Urologic Care are committed to offering state-of-the-art urologic care that encompasses the whole person, with recognition of the stress and anguish that urologic problems can cause. At this dynamic practice, genuine healing is provided. “We offer the very best urologic care and we love what we do,” says Dr. Lutins. “We have multiple locations, an efficient system and an excellent staff, and our patients are very appreciative. With this merger, we are enhancing urologic health for the region.” n Arthur D. Thomas, M.D.
ARTHUR D. THOMAS, M.D. Dr. Thomas specializes in urology. He earned his medical degree at the University of Pennsylvania, Philadelphia, where he also completed a residency. Dr. Thomas is board-certified in urology. Dr. Thomas was named a Best Doctor in Urology in Pittsburgh Magazine’s 2020 Best Doctors report. He practices with St. Clair Medical Services. To contact Dr. Thomas, please call 412.572.6194.
Shailen S. Sehgal, M.D.
SHAILEN S. SEHGAL, M.D. Dr. Sehgal specializes in urology. He earned his medical degree at Weill Cornell Medical College, New York City, and completed a residency and fellowship at the University of Pennsylvania, Philadelphia. Dr. Sehgal is board-certified in urology. He practices with St. Clair Medical Services. To contact Dr. Sehgal, please call 412.572.6194.
Volume XII Issue 3 I HouseCall I 5
UROLOGIC HEALTH Continued from Page 5
PATIENT PROFILE: TOM FERRANTE
Enjoying every single day Tom Ferrante, 67, of Bethel Park, and his best friend, John, are
meaning that he was able to protect and spare the nerves that are
former co-workers and golf buddies, with a solid, comfortable friendship
responsible for bladder control and erections. “Tom’s was a localized
that has lasted 40-plus years. When Ferrante learned earlier this year
cancer, which we were able to take care of with surgery; he did extremely
that he had prostate cancer, he turned to John, who had been successfully
well and did not need chemotherapy or radiation. I do a lot of prostate
treated for the exact same type of prostate cancer not long ago. John
surgery (St. Clair’s prostate cancer program is a leader in the region) and
provided advice and support, and most importantly, a referral to an
nerve monitoring is well worth it. It only adds a few minutes to the
exceptional surgeon: Kevin P. Bordeau, M.D., a board-certified urologist
procedure. It gives the patient the best possible opportunity to get urinary
at St. Clair Hospital.
control and erections back. It makes a big difference to the patient. The fear
“I was getting the recommended screenings, and in February of 2020 my PSA (prostate-specific antigen*) level went up to 7.2. The acceptable
of losing these functions can keep men from getting the care they need. “The most important issue in prostate cancer is early detection, with
range is 0 to 3, so this was a red flag. I was fortunate to get an appoint-
PSA screening. In the past, this was controversial, before we realized
ment with Dr. Bordeau quickly, and he explained to me that an elevated
that some slow-growing prostate cancers can be watched with active
PSA doesn’t automatically mean you have cancer. But a low PSA doesn’t
surveillance for 10-15 years. It has to be individualized: you can be 70 and
mean that you don’t have cancer – and the only way to know with certainty
live to be 90 with a slow growing cancer. We can also get more aggressive
is to have a biopsy. My biopsy was positive for cancer, so my wife, Diana,
with cancers that may affect life expectancy; those must be treated.”
and I met with Dr. Bordeau together and he laid everything out for us.
Since the surgery, Ferrante has been monitored with regular PSA
He explained the options, the pros and cons, and the procedures in detail.
testing and the results are consistently “undetectable.” “Dr. Bordeau got
It came down to a choice between radiation therapy, five days a week for
all the cancer; my bone and body scans are negative. I had a far better
nine weeks, or robotic-assisted prostate surgery. His recommendation
outcome than I expected. I have complete recovery of urinary and sexual
was surgery, and I agreed.”
function. For a few months, I experienced occasional leakage, but it was
Ferrante’s surgery was scheduled for late March, but there was an unexpected glitch when Diana, who is also retired, experienced a COVID19 exposure and developed symptoms. She ultimately tested negative, but
just an inconvenience and it has resolved completely.” Ferrante encourages his friends to follow the recommendations for PSA testing. “I never had any symptoms. We wouldn’t have found the cancer this
the surgery had to be delayed and finally took place on May 1 at St. Clair.
early if I had not been getting PSA testing. I encourage all my friends to get
Ferrante felt confident about his surgeon and the Hospital. “Dr. Bordeau is
their screenings – don’t put it off, because it can save your life.”
very impressive, on every level – his credentials, his bedside manner and
Now, with a clean bill of health, Ferrante is on the threshold of a major
his straightforward way of communicating with us,” Ferrante says. “I knew
life change as he and Diana prepare for a move to Houston. Their daughter,
that John had an excellent experience with him. I had been treated at
Kelly, 29, an elementary school teacher there, is getting married in July
St. Clair in the past, for atrial fibrillation, and I had only positive feelings
and Ferrante is looking forward to walking his daughter down the aisle.
about the Hospital.”
“Kelly loves it there, and Diana and I love visiting, so we’ve decided to
The surgery went flawlessly, and Ferrante says he had virtually no
relocate there. The cancer experience is a journey, and it’s been daunting,
pain post-operatively. “There was a little discomfort, but nothing bad
but I had tremendous trust in Dr. Bordeau. He eased my mind and made
enough that I needed pain medication. I spent one night in the Hospital and
me feel so comfortable. If this happens to you, I highly recommend him.”
I recovered quickly at home. The technology that makes robotic-assisted
Ferrante says that he is as good as ever now, making plans for the
surgery possible is amazing. It’s less invasive, there’s very little bleeding
future and feeling excited about the wedding this summer. He’s enjoying
and you heal quickly.”
every single day, and is eager to get back on the golf course with his
Dr. Bordeau performed a robotic prostatectomy with nerve monitoring,
good friend, John. n * A PSA blood test measures a protein, normally produced by the prostate, which can be elevated in the presence of prostate cancer. It is a non-specific test, however, that can also indicate infection, inflammation or benign prostate enlargement.
6 I HouseCall I Volume XII Issue 3
“ ”
Dr. Bordeau eased my mind.
TOM FERRANTE, PATIENT
Tom Ferrante
Volume XII Issue 3 I HouseCall I 7
UROLOGIC HEALTH Continued from Page 7
“
I’m so grateful … Dr. Lutins changed my life.
”
JAICEY STEGENA, PATIENT
Jaicey Stegena
8 I HouseCall I Volume XII Issue 3
PATIENT PROFILE: JAICEY STEGENA
Forever grateful For her 21st birthday, Jaicey Stegena received the gift of a lifetime – a gift that transformed her body and her life. Since the age of 2, Stegena, now 27, of Munhall, lived with a rare condition called neurogenic bladder, which prevented her from being able to urinate naturally. Stegena did not experience the sensation of a full bladder and could not empty her bladder in the normal way. As a result, she had to be catheterized by her parents several times a day, to remove accumulated urine. Remarkably, Stegena learned to do this by herself at the tender age of 5. Her parents, Jay and Winnie Stegena, wanted their daughter, the last of their four children, to have as much normalcy and independence as possible. Stegena was healthy in every other way, and every bit as active as her siblings. Her mother taught her to perform a procedure known as “clean intermittent catheterization,” inserting a catheter into her bladder several times a day. Stegena became proficient at this, but it was never easy, and she endured years – 19 years, to be exact - of frequent urinary tract infections and prolonged courses of antibiotics. Like all teenagers, Stegena wanted to be like her peers. As adulthood approached, she felt increasingly despondent about her condition. Her loving parents had taken her to specialist after specialist, all over the region and beyond. No one offered them a solution – until the day they met Jay A. Lutins, M.D., a board-certified urologic surgeon who practices with St. Clair Medical Services at St. Clair Hospital. Stegena, who works as a certified medical assistant at a physicians’ office in the South Hills, remembers that red-letter day with perfect clarity. “I was about to have my 21st birthday. My step-grandfather’s friend told him about an excellent urologist whom he knew. I was so discouraged and defeated by then, and I felt that this new doctor was my last hope. His name was Jay – I thought that was a positive sign because that is my Dad’s name. I went to the first appointment with my mother, my sister and her baby. Dr. Lutins walked in to the exam room, went straight to the baby and picked him up. He held my nephew on his lap through the appointment, while he talked to me. That showed me the type of person he is – kind, with a good heart.” Dr. Lutins told Stegena about a new technology that might help her, but he couldn’t make any promises. “Not many surgeons were doing this procedure, he said, and I would be one of the first to have it done for this problem. He was honest. He said, ‘Let’s try it.’” The bladder’s job is a simple one – it stores and eliminates urine. But the elements that control urination are not nearly so simple and involve complex communication between the brain and the bladder. When one has a neurogenic bladder, the nerves that normally direct the bladder to hold or expel urine fail to work as designed, and the person cannot control the emptying of the bladder. Neurogenic bladder can be a congenital or acquired condition. In children, it may be due to a spinal anomaly called spina bifida or to cerebral palsy. In adults, it is sometimes associated with Parkinson’s disease, multiple sclerosis or a spinal cord injury. Neurogenic bladder can sometimes be treated with lifestyle changes, medication or exercise, but when urinary retention is the problem, patients usually have to manage it with self-catheterization. Although it
works, that can be a practical daily challenge and a quality of life issue. The new approach that Dr. Lutins proposed was sacral neuromodulation, a treatment that was being used effectively for the opposite conditions of urinary incontinence and urinary retention. It uses a device called an InterStim, a sacral nerve stimulation system. The technology consists of a battery-operated, implanted stimulator that is placed under the skin in the upper buttock and attached to a lead wire. The stimulator generates an electrical impulse that travels through the lead wire to the sacral nerve and then to the bladder. The device provides normal signaling between the brain and the bladder. The patient receives a remote control which allows her to control and reprogram the stimulator and check the battery, as needed. “I was ready for this,” Stegena says. “I had the procedure done at St. Clair Hospital, right after my 21st birthday. Dr. Lutins implanted the InterStim and it worked immediately: I urinated without a catheter for the first time. Dr. Lutins implanted it on the outside of my body first, for a two week trial. It’s the size of a pacemaker, and after the trial was successful he implanted it under the skin. Now I urinate normally. Before this, I could never tell when I needed to go; I never felt the sensation of a full bladder. The technology is amazing. I can turn it off and on. I can change the settings if I want to. I’m so grateful to have it.” Dr. Lutins had implanted sacral nerve stimulators previously, in patients with overactive bladder and incontinence, but Stegena’s case was exceptional. “I wasn’t entirely sure that the InterStim was going to work for Jaicey,” he recalls. “Her bladder simply did not work, but there was no clear reason for that. She did not have spina bifida or any congenital condition to explain it. Her problem was urinary retention, which is unusual. She could not expel urine. Many women have the opposite problem, in that they cannot hold urine and have incontinence. We use sacral neuromodulation for that too, more commonly.” Getting the sacral nerve stimulator was an emotional experience for Stegena, and for her parents and family, Dr. Lutins recalls. “Her father cried when we realized that it was working. It’s a great solution: it’s low maintenance and long term; we have to change the battery every five years, but that is a simple outpatient procedure.” The implant has given Stegena freedom and possibilities that she once did not expect to have. She is getting married next year to Bill Stevens and they plan to have a big family. “Bill accepted me for me, and never made me feel insecure about my medical condition. He is my champion.” Stegena and Stevens are outdoor enthusiasts who go camping and ride four-wheelers on the weekends – a vigorous activity that once caused her to need a replacement of her implant. “I was riding in the woods and had an accident; the implant became dislodged.” Dr. Lutins is her personal hero. “Dr. Lutins is special to me and to my family; my family has great faith in God and we prayed every night for a cure for me. I was able to endure it for so many years because I reminded myself that other people were worse off than me. No one else was able to help me. Dr. Lutins changed my life. Thanks to him, I can now live the life that I always dreamed of.” n Volume XII Issue 3 I HouseCall I 9
ADVANCES IN NEUROLOGY
St. Clair Welcomes Our New Chief of Neurology MAXIM D. HAMMER, M.D. Setting a higher standard of neurologic and stroke care Maxim D. Hammer, M.D., has been named Chief of Neurology at St. Clair Hospital, joining the medical staff last October. “I’m excited to take a leadership role at St. Clair
of persons with multiple sclerosis, epilepsy, headache and movement disorders, including Parkinson’s disease. Preventive care is of great interest for Dr. Hammer, who
and help turn a good system in neurology into an even better
hopes to give it a special focus at St. Clair. “Preventive care
one,” Dr. Hammer says. “The program has a number of
doesn’t get the spotlight it deserves,” he says. “There is not
strengths, including doctors who are excellent at what they
enough attention given to preventing strokes, heart attacks and
do, as well as an eager, experienced staff, and that is the right
dementia. We know that 80 percent of strokes and heart attacks
recipe for success.”
are potentially preventable, and the key word is ‘potentially’.
Dr. Hammer is board-certified in neurology and vascular
What that really means is that 80 percent of strokes involve
neurology and is a specialist in the diagnosis and treatment of
risk factors that can be modified. It’s a matter of changing the
strokes. At St. Clair, he is enhancing the care of stroke victims
culture to keep people active and healthy.”
by improving acute care and bridging the gap between hospital
Dr. Hammer is passionate about patient-centered care
care and post-discharge care, primarily through telemedicine.
and shares St. Clair’s fervent, hospital-wide commitment to
Since January 2020, St. Clair has been offering CT perfusion
improving the patient experience. “St. Clair’s leadership has a
scanning, an advanced brain imaging technology that has
vision for the culture to be centered on the patient experience.
enhanced St. Clair’s capability to evaluate, diagnose and
I strongly share this vision and want to be a part of this at
manage strokes more effectively, improving outcomes. (Please
St. Clair. Patients are our reason for being here. We strive
see sidebar, Page 12). Dr. Hammer’s plans for the Division of
for good clinical outcomes, but often forget that the patient
Neurology Department include a multidisciplinary approach
and family can have a bad experience even with a good
to the care of dementia patients, incorporating neurology
clinical outcome. I was first exposed to this idea when I was
with psychiatry, psychology and social work. He also intends
at Washington Hospital Center at Georgetown. There was an
to collaborate with the neurology team to enhance the care
attending (physician) there who was extraordinarily Continued on Page 13
10 I HouseCall I Volume XII Issue 3
Maxim D. Hammer, M.D.
Volume XII Issue 3 I HouseCall I 11
ADVANCES IN NEUROLOGY
CT PERFUSION SCANNING Advanced imaging technologies have dramatically enhanced St. Clair’s capability to evaluate, diagnose and manage strokes.
In January of last year, St. Clair Hospital
CTP is especially useful in the evaluation
study. The research demonstrated that in the
began providing an advanced brain imaging
and management of “wake-up strokes,”
appropriate patients, the treatment window
technology that has transformed the way
says Maria Abraham, MPAS, PA-C, Director,
for clot removal could be expanded from
some stroke patients are diagnosed and
Neuroscience Service Line at St. Clair. “A
six to 24 hours after the patient was last
treated. CT perfusion scanning (CTP) is a
wake-up stroke means that a person goes
known to be well. In doing so, they were able
specialized CT scan of the brain that can
to bed in their normal condition but wakes
to show a significant decrease in disability.
assess perfusion (blood flow) of brain tissue
up in the morning with stroke symptoms.
“Specifically in patients with stroke caused by
in persons who are believed to have suffered
There’s no way to know the time of onset of
either a carotid occlusion or middle cerebral
an ischemic stroke, the type that occurs
those symptoms. Prior to 2018, the standard
artery occlusion, there was some benefit to
when a clot obstructs a large blood vessel
of care has been to offer clot removal only
clot removal in certain situations. By adopting
in the brain. CTP provides St. Clair’s stroke
when it was known to have occurred within
CTP imaging protocols, we are now able to
care team with critical information about
the previous six hours. As a result, persons
make those same determinations,” Abraham
brain ischemia, infarcted (dead) brain tissue
with wake-up stroke symptoms had limited
explains.
and abnormalities in blood flow. It enables
options. Only those who presented within six
Stroke is the fifth leading cause of death
them to identify which areas of the brain are
hours of last being well were considered for
in America, after heart disease and all
damaged and which are at risk of further
endovascular clot removal, if indicated.”
cancers combined, and is the leading cause
damage in specific stroke types. CTP imaging
A transformative change in stroke care
of permanent, life-altering disability. About
helps guide both diagnosis and treatment of
was brought about in 2018 by the release
795,000 strokes occur in the U.S. every year,
ischemic stroke, and can improve stroke
of the results of two major, multicenter
according to the National Stroke Association,
care.
studies: the DAWN study and the DEFUSE-3
with 75 percent affecting persons over the age of 65. Nearly 90 percent of strokes are ischemic strokes. Traditionally, clinical decisions about stroke treatment have been largely time-based. “Time is brain” has served as an imperative: the earlier that treatment is initiated, the greater the chance to limit or reverse brain damage and achieve a favorable outcome. This remains true, but now, with the availability of CTP imaging, the condition of brain tissue also determines treatment. ”Anyone with stroke symptoms should go immediately to an emergency room (ER),” says Abraham. “With the use of advanced imaging, St. Clair’s ER team will perform a comprehensive assessment, and determine the best treatment options for our patients.” n
Maria Abraham, MPAS, PA-C, Director, Neuroscience Service Line at St. Clair.
12 I HouseCall I Volume XII Issue 3
Continued from Page 10
compassionate – he even helped feed the patients. He made a strong
“The beauty of my specialty is that technology can’t always get you
impression on me. More recently, in 2017 and 2018, I had an opportunity
answers in neurology; you have to rely on physical examination and
to spend a one-year sabbatical at Cleveland Clinic Abu Dhabi, which is
patient interviewing to reach a diagnosis. When people seek outpatient
a world leader in providing the best patient experience. Their goal is
care for neurological problems, such as headaches – the number
to always exceed the patient’s expectations for excellence. This was a
one reason for seeing a neurologist – they cannot be diagnosed with
transformational experience for me.
any technology. The same is true for Alzheimer’s disease, seizures,
“Physicians need to become more mindful of how we speak to
concussions and Parkinson’s disease. It’s truer of neurology than any
patients and families, and how we spend health care resources. In
other specialty. We need to train doctors differently, with less reliance
the U.S. we spend money freely – we overtest and overtreat – but the
on technology.”
cost of this gets passed onto patients in the form of higher premiums. We need to consider these things and control costs better.” Before joining St. Clair, Dr. Hammer held numerous titles, including
Dr. Hammer is a native of Montreal who lives in Squirrel Hill with his wife, Robin, whom he met in high school. They have three children and have resided in Pittsburgh for 18 years. He is an avid reader who enjoys
Vice Chairman of Clinical Affairs in the Department of Neurology at
philosophy and history. He manages his own health with a daily, one-hour
UPMC. Other concurrent and past titles include Clinical Director of
morning exercise routine, a strict healthful diet and plenty of activity.
Neurology at UPMC, and Director of Stroke Services at UPMC Mercy
“I feel very fortunate to find myself at St. Clair Hospital and to be in a
Hospital. Dr. Hammer earned his medical degree at Albany Medical
position to further develop the neurology service,” he says. “My overall
College and completed his neurology residency at Cleveland Clinic,
goal is to help provide comprehensive and readily accessible services for
where he was elected chief resident. He also completed a Vascular
the region, so people feel comfortable and confident staying in their own
Neurology Fellowship at UPMC. Dr. Hammer continues to hold the
area for their health care.” n
rank of associate professor, Department of Neurology, at the University of Pittsburgh School of Medicine. He is board-certified in neurology, as well as in vascular neurology. Dr. Hammer was named a “Best Doctor” in Neurology in Pittsburgh Magazine’s 2020 Best Doctors list. He also holds an executive healthcare master’s degree in business administration from the University of Pittsburgh Katz School of Business, and is combining his experience and the knowledge he gained from that advanced degree to practice value health care, which means improved clinical outcomes and reduced costs, at St. Clair. Dr. Hammer practices with St. Clair Medical Services and his office is located at the
Maxim D. Hammer, M.D.
St. Clair Hospital Outpatient Center in Peters Township.
MAXIM D. HAMMER, M.D. Dr. Hammer earned his medical degree at Albany Medical College, Albany, N.Y., and completed his neurology residency at Cleveland Clinic, where he was elected chief resident. He also completed a Vascular Neurology Fellowship at UPMC. Dr. Hammer was named a “Best Doctor” in Neurology in Pittsburgh Magazine’s 2020 Best Doctors report. Before joining St. Clair, he held numerous titles, including Vice Chairman, Clinical Affairs, Department of Neurology; Clinical Director of Neurology; and Director of Stroke Services at UPMC Mercy Hospital. Board-certified in both neurology and vascular neurology, he also currently serves as an associate professor, Department of Neurology, at the University of Pittsburgh School of Medicine. Dr. Hammer practices with St. Clair Medical Services at St. Clair Hospital Outpatient Center–Peters Township. To contact Dr. Hammer, please call 412.942.6300.
Volume XII Issue 3 I HouseCall I 13
ADVANCED CARDIAC CARE
Breakthrough MitraClip procedure now offered at St. Clair ™
T
he human heart is a perfect example of the principle of form following function. An industrious pump that propels blood, all day, every day, on its life-giving journey through the body, the heart is perfectly designed for the job. Blood flows through
the heart’s four chambers – the atria on top, the ventricles on the bottom – in one direction, through four one-way valves that assure efficiency of operation. These valves function like little swinging gates, opening and closing their “leaflet” flaps of thin, delicate tissue with every contraction of the heart. The mitral valve is on the left side of the heart, between the left atrium and the left ventricle. Freshly oxygenated blood from the lungs re-enters the heart through the left atrium and passes through the mitral valve to the left ventricle, which pumps it via the aorta to the body. With aging or injury, the mitral valve may deteriorate and malfunction; if it becomes weak, enlarged or torn, it fails to close tightly and excess blood flows through the valve in such a way that some of it backflows into the lungs. This is known as mitral regurgitation, sometimes called a leaky valve.
14 I HouseCall I Volume XII Issue 3
Mitral valve regurgitation is the most common form of valve disease
Dr. Cater is a world-class echocardiologist and cardiac imaging specialist,
in the U.S.; one in 10 Americans over the age of 75 has some degree of it.
and an expert in this procedure; although the procedure requires a
Many are unaware of it, if it is mild and they have no symptoms. For them,
multi-disciplinary team, it is directed primarily by him.”
it may never be a problem, but for others an untreated leaking mitral valve
“The MitraClip is one more way that we can help people with mitral
can become progressively worse, causing symptoms, including shortness
valve disease who are very sick,” says Dr. Cater, who joined St. Clair
of breath, fatigue, swelling of feet and ankles, dry cough and excessive
Hospital last summer. (Please see related patient story, Page 18.)
urination. Eventually, mitral regurgitation can lead to heart failure, severe
“When their hearts can no longer compensate for the leaking valve,
illness and death. “As the mitral valve leaks and blood flows back into the
and they are too frail for surgery, this is an option that can help. We’re
lungs, there is an increased load on the heart; the ventricle has to work
very careful about who is likely to benefit. It’s not for everyone who has
harder to pump and it gradually dilates,” explains Andy C. Kiser, M.D.,
mitral regurgitation.”
chief of cardiac surgery at St. Clair Hospital and a nationally recognized
Preparation for the MitraClip implantation includes extensive imaging
expert on valve disease. “An enlarged ventricle cannot function effectively
studies: initially a screening transthoracic echocardiogram; then a
and this leads to heart failure. We frequently see patients with mitral
transesophageal echocardiogram where quantification and 3D pictures of
regurgitation in St. Clair’s Heart Failure program.”
the mitral valve are acquired; coronary angiogram, neck ultrasound and if
The standard treatment for mitral valve regurgitation is valve
necessary, quantification of the volume of regurgitation with cardiac MRI.
replacement or repair, performed as a major surgical procedure that Continued on Page 16
involves opening the chest and temporarily stopping the heart. But many people who have mitral valve disease cannot tolerate such a procedure, due to severe heart failure, age, frailty, or co-morbid conditions (more than one disease is present and is often chronic or long-term). “Many older adults with a severely deteriorated mitral valve and heart failure are too clinically high-risk for open heart surgery,” Dr. Kiser says. Now St. Clair is offering a new option for those patients: transcatheter mitral valve repair (TMVR), a minimally invasive procedure in which a small device called a MitraClip is implanted in the heart to more completely close the mitral valve, restoring normal blood flow. The MitraClip joins the valve’s leaflets together and holds them in place. “The MitraClip can keep the patient out of heart failure,” says Dr. Kiser. “Once it is in place, the valve is no longer leaking and the blood is flowing
Andy C. Kiser, M.D., FACS, FACC, FCCP, MBA
in the right direction again. Their heart failure becomes much more manageable.” According to Dr. Kiser, patients in St. Clair’s Heart Failure program will benefit the most from having the MitraClip procedure. “We’re excited to be able to offer the MitraClip to people with heart failure due to mitral valve disease; it will decrease heart failure and mortality. We’re able to offer the MitraClip because George Cater, M.D., is now here at St. Clair.
ANDY C. KISER, M.D., FACS, FACC, FCCP, MBA Dr. Kiser specializes in cardiac and thoracic surgery. He earned a B.S. in biology with honors and distinction, and a medical degree with honors from the University of North Carolina at Chapel Hill. He subsequently completed a residency in general surgery there, as well as fellowships in cardiac and thoracic surgery. From 2011 to 2016, he served as the Chief of the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill, where he was also the Byah Thomason-Sanford Doxey Distinguished Professor of Surgery. Dr. Kiser served as the J. Mark Williams Distinguished Professor in Cardiac Surgery, Chief of Cardiac Surgery, and the Director of Cardiovascular Surgical Services at East Carolina University Heart Institute, which is affiliated with East Carolina University, in Greenville, North Carolina. In May, 2018, Dr. Kiser earned an MBA degree from the Kenan-Flagler Business School, also part of the University of North Carolina at Chapel Hill. Dr. Kiser practices with St. Clair Medical Services. To contact Dr. Kiser, please call 412.942.5728.
Volume XII Issue 3 I HouseCall I 15
ADVANCED CARDIAC CARE Continued from Page 15
This level of precision is essential because to be effective, the clip
An ensemble of St. Clair’s cardiac specialists play very specific,
must be in exactly the right spot and the valve must have suitable
synchronized parts: Dr. Cater and Christopher Pray, M.D., guide the
anatomy. The TMVR procedure takes place in the Hospital’s cardiac
entire procedure through real-time echocardiography imaging.
catheterization lab, where the patient is placed under general
Jeffrey C. Liu, M.D., an electrophysiologist, gains access to the left
anesthesia and a thin guide catheter is introduced percutaneously
atrium by making a tiny puncture, using a special needle, to move the
into a vein, through a small upper leg incision, and directed toward
catheter across the septum. Ryan W. Zuzek, M.D., an interventional
the heart. The MitraClip, which is smaller than a dime and is covered
cardiologist, and Dr. Kiser, at Dr. Cater’s direction, then bring the
with fabric, is attached to a device called the clip delivery system, and
catheter delivery system into the left atrium and direct it down over
guided to the mitral valve through the guide catheter. “ To reach the
the valve, capturing and grasping the leaflets and bringing them
mitral valve, we go up on the right, through the inferior vena cava to the
together so that the edges are approximated. The procedure lasts
right atrium. We cross over the interatrial septum, the wall between
several hours and most patients are discharged in two or three days.
the atria, to get to the left atrium. The procedure is simple in concept
“The trickiest part is going through the wall that separates the
but complex in execution, and the technology works remarkably well,”
atria,” Dr. Cater explains. “So we have to communicate and collaborate
Dr. Cater says.
with great accuracy.” The MitraClip is changing lives, says Dr. Cater, helping people who are very sick, improving their heart failure and enhancing their quality of life. For him, this is immensely satisfying. “It’s exciting to see the patient get better. Many patients experience immediate relief of symptoms,” he says. Dr. Cater came to St. Clair for the opportunity to do advanced cardiac imaging. “I’m excited by how the heart program is growing here,” he says. “St. Clair is introducing new, cutting-edge technologies, such as stress cardiac MRI, 3D echocardiography and coronary artery CT scanning. In the new Dunlap Family Outpatient Center, we’ll have excellent technology for diagnosing and treating heart disease for the region. We’ll be able to help a lot of people.”
George Cater, M.D., MSE, FACC
Dr. Cater has degrees in both chemical and biomedical engineering as well as medicine, and has completed fellowships in cardiology and advanced cardiac imaging. “Cardiology is a natural segue from engineering,” he says. “The heart is a physics-based organ, a pump. Engineering is a problem-solving profession, as is medicine, and when I apply my engineering skills to medicine, I can think about problems in a non-traditional way.” “It’s exceptional to find a non-academic hospital that is offering transcatheter mitral valve repair,” says Dr. Kiser. “Not many hospitals have this technology. We are planning to do more MitraClip procedures that will result in reduced heart failure and mortality. It’s one more item in the toolbox to help people with heart disease.” n
GEORGE CATER, M.D., MSE, FACC Dr. Cater specializes in non-invasive cardiology and cardiac imaging. He earned his medical degree at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and completed his residency as well as fellowships in cardiovascular medicine and advanced cardiac imaging at UPMC. Dr. Cater is board-certified in general internal medicine, echocardiography and cardiovascular disease. He practices with St. Clair Medical Services. To contact Dr. Cater, please call 412.942.7900. 16 I HouseCall I Volume XII Issue 3
Transcatheter Mitral Valve Repair (TMVR)
The MitraClip procedure ™
The MitraClip is a minimally invasive heart valve repair procedure involving implanting a clip in the heart through a catheter-based procedure. This new procedure does not require opening the chest and temporarily stopping the heart.
The MitraClip device is a tiny metal clip, smaller than a dime, covered with a polyester fabric.
1
The MitraClip and catheter are inserted into the femoral vein through a small incision near the groin.
2
The MitraClip is guided by ultrasound and Xray imaging, and is moved upwards through a catheter to the heart.
2
1
Source: MitraClip.com
4
5
3
3
The MitraClip enters the right atrium of the heart and crosses into the left atrium above the damaged valve.
4
The clip enters the damaged mitral valve, and its two levers clamp the valve shut, reducing the backward flow of blood.
5
The catheter detaches from the clip and is withdrawn.
Most patients experience improvement in their related symptoms and quality of life soon after the procedure.
Volume XII Issue 3 I HouseCall I 17
ADVANCED CARDIAC CARE Continued from Page 17
Paula Barr
Henry Barr
“
I felt better right away. I could breathe, without any shortness of breath. It felt miraculous.
”
HENRY BARR, PATIENT
18 I HouseCall I Volume XII Issue 3
PATIENT PROFILE: HENRY BARR
A life-changing difference Henry Barr, 77, was struggling through the physical therapy sessions
disease, a field in which he has exceptional expertise: Dr. Kiser played a
that were part of his rehabilitation following a series of complicated
role in developing the technology for the minimally invasive repair and
leg surgeries. He was not progressing as expected and found himself
replacement of failing heart valves, including transcatheter aortic valve
becoming breathless as he performed the prescribed exercises.
replacement, or TAVR. In 2020, he opened a Heart Valve Clinic at St. Clair
“I was short of breath, and I assumed that this was a normal aspect of
in order to offer advanced therapies, including the MitraClip, for complex
the intense therapy. I thought it would start to improve as my therapy
valve disease and heart failure.
progressed, but instead it got worse. I thought there might be something
“A leaking heart valve can greatly impact quality of life and activities
wrong with my lungs, so I made an appointment to see a pulmonologist.
of daily living,” Dr. Kiser explains. “It can lead to heart failure and death.
He found that my lungs were healthy and recommended that I see a
But people with structural heart disease often cannot go to the operating
cardiologist.”
room to have their heart problems repaired, because they are too frail
An echocardiogram ordered by the cardiologist revealed that Barr
and may have severe heart failure. With the MitraClip, we can close the
had mitral regurgitation, a condition in which the heart’s mitral valve fails
valve so that normal blood flow is restored. Mr. Barr was clearly a good
to close completely, leading to a backflow of blood that causes shortness
candidate for the MitraClip. He had been admitted with a severe episode
of breath and forces the heart to work harder to pump the leaking blood.
of heart failure and was referred to me because of the mitral
The heart can compensate for a while, but eventually it cannot meet the
regurgitation problem.”
increased demand; as a result, the heart muscle weakens, fluid builds up
The procedure took place in St. Clair’s Cardiac Catheterization
in the lungs and symptoms worsen. “I was aware that I had mitral valve
Lab, with the Hospital’s team of cardiac specialists working together:
prolapse; I had a heart murmur throughout my life,” Barr says. “But it had
George Cater, M.D., cardiac imaging specialist; Jeffrey C. Liu, M.D.,
never caused a problem before. The regurgitation was a new problem, and
electrophysiologist; Ryan W. Zuzek, M.D., cardiac interventionist; and
it was progressing rapidly. My shortness of breath increased to the degree
Dr. Kiser. When Barr woke up two hours later in the recovery unit, he
that I needed to have oxygen on a 24-hour basis. I felt very weak with no
knew immediately that the procedure had been successful. “I felt better
energy.” That’s unusual for this retired attorney and former prosecutor,
right away. I could breathe, without any shortness of breath. It
who lives in Mt. Lebanon with his wife Paula. They raised their family of
felt miraculous.”
four sons — David, Scott, Jonathan and James – in Bethel Park, and now have four grandchildren, with a fifth on the way. Barr was referred to Christopher Pray, M.D., a board-certified
Says Dr. Kiser: “We were able to fix his mitral valve with the MitraClip and stop the leaking so the blood could flow through his heart in the right direction again, and keep him out of heart failure. Post-op, his heart
cardiologist and director of cardiac imaging at St. Clair Hospital, who
began pumping much more effectively, so that his lungs cleared of the
ordered additional diagnostic tests, including a cardiac MRI. Dr. Pray
excess fluid right away.”
informed Barr that St. Clair was performing advanced, minimally invasive
Barr spent two nights recovering at the Hospital, followed by a
heart procedures that, in some situations, obviated the need for open-
one-week stay at a skilled nursing facility. Although he was on oxygen
chest heart surgery. He suggested that Barr see Andy C. Kiser, M.D.,
post-operatively, he has been breathing regular room air for months now,
chief of cardiac surgery at St. Clair. “I knew about Dr. Kiser from reading
and his breathing is effortless. He is looking forward to resuming his
HouseCall magazine,” Barr says. “I was eager to see him. Dr. Kiser
rehabilitation, in two phases: physical therapy first, to strengthen his leg,
explained mitral regurgitation and heart failure to me, and I was excited
and then cardiac rehab at St. Clair.
to learn that St. Clair was offering a new option, the MitraClip, for the
“The MitraClip procedure changed my life,” he says. “I’m grateful to
treatment of mitral regurgitation. I learned that I would be the first patient
my wife Paula, who took care of everything for me, and to my boys, who
to undergo the procedure at St. Clair, but that didn’t bother me, because
all came home when I had the procedure. I had tremendous support.
Dr. Kiser had done it before.”
I advise anyone who has mitral regurgitation and is eligible for this
When Dr. Kiser became the chief of cardiac surgery at St. Clair
procedure to go for it. It’s safe, there’s no discomfort and it works. At
Hospital two years ago, one of his goals was to establish a comprehensive
the end of my last visit with Dr. Kiser, he said to me, ‘See you in about a
program for advancing the diagnosis and treatment of heart valve
year.’ I feel fortunate and grateful to Dr. Kiser and the entire team.” n
Volume XII Issue 3 I HouseCall I 19
MENTAL HEALTH
Addressing the Psychological Fallout of COVID-19
T
he physical toll of COVID-19 is widely known. Patients who have tested positive with the coronavirus experience a wide
range of symptoms, ranging from difficulty breathing, to head and body aches, to fevers, to a loss of taste and smell, to even something called “COVID toe.� But the mental and emotional impacts from COVID-19 are very real, too, both with people who have had the virus and those who are susceptible to contracting it, which, unfortunately, is just about everyone.
20 I HouseCall I Volume XII Issue 3
Bruce A. Wright, M.D., Chair, Department of Psychiatry at
The mental health expert says everyone handles stress differently,
St. Clair Hospital, says the threat of COVID-19, along with the onset
but he offers some advice that should apply to just about all of us:
of the flu season and seasonal affective disorder, have sent stress
• Try to maintain as much normalcy in your daily routine. Exercise,
levels to an all-time high. “Perhaps the most obvious reason this pandemic has been so stressful, is a fear, at times overwhelming, of becoming infected – or having someone we care about being infected. Sometimes, you can’t help but think you might be the next statistic.” Dr. Wright says that stress is often compounded by the wide range of differing opinions on how to protect ourselves from the virus, when the COVID-19 vaccine might be available for wide distribution, and when our daily lives will return to some semblance of normalcy. Moreover, says Dr. Wright, most of us probably haven’t been properly caring for ourselves since the pandemic began in earnest. “Our ability to handle this stress may be adversely affected by a general decline in our physical well-being. We may not be exercising or maintaining a healthful diet, even though we know through
eat healthfully, and maintain a regular sleep schedule. • Limit expectations. Life as we know it has been dramatically altered by the coronavirus, so we shouldn’t expect people to act as they did pre-COVID-19 and we should try not to be too disappointed when we can’t participate in activities as we used to. • Stay as close to friends and family as possible by taking the initiative to keep all lines of communication open (even if you have to do it online). • Stay informed. But only seek science-based information from reliable sources, such as St. Clair, Mayo Clinic, county and state health departments, the Centers for Disease Control and Prevention, the National Institutes of Health, and the World Health Organization. • Seek advice from your personal care physician or a mental health professional. Dr. Wright says there is no secret formula to getting past the mental
experience that regular exercise and healthful eating are necessary
and emotional suffering brought on by COVID-19. “We just have to do
to combat stressors.”
the right things – stay connected, stay active, eat well, do what you can
Dr. Wright says it’s possible that stress can affect every aspect of an individual’s life – their interpersonal relationships, their ability to enjoy life, their sleep, appetite, energy and mood. Many people, he says, find it harder to cope, more difficult to interact with others, and that they simply “don’t enjoy things like they used to.”
to enjoy yourself and your family. And if things become too much, too overwhelming, reach out for help.” n For more information on psychiatric and mental health services – inpatient and outpatient – at St. Clair Hospital, please call 412.942.4800.
Bruce A. Wright, M.D.
BRUCE A. WRIGHT, M.D. Dr. Wright is the Chair of the Department of Psychiatry at St. Clair Hospital. He earned his medical degree at the University of Pittsburgh School of Medicine, and completed his residency at UPMC/ Western Psychiatric Institute & Clinic. Dr. Wright is board-certified by the American Board of Psychiatry & Neurology-Psychiatry. He practices with St. Clair Medical Services and Associates in Clinical Psychiatry, P.C. To contact Dr. Wright, please call 412.347.0170.
Volume XII Issue 3 I HouseCall I 21
CANCER CARE
Cancer Care to be a centerpiece of St. Clair’s new Dunlap Family Outpatient Center St. Clair and UPMC Hillman Cancer Center Collaborate in New Outpatient Center The spring 2021 opening of St. Clair’s new Dunlap Family Outpatient Center will mark a major milestone for South Hills residents being treated for cancer. As part of an affiliation, UPMC Hillman Cancer Center will consolidate its satellite office and services at Village Square into the St. Clair Hospital Cancer Center, which will occupy 20,000-square-feet on the seventh floor of the new Dunlap Family Outpatient Center.
Vincent E. Reyes, Jr., M.D.
“
THIS BEAUTIFUL NEW ENVIRONMENT WILL ENHANCE OUR CARE OF PATIENTS WITH CANCER TREMENDOUSLY.
”
VINCENT E. REYES, JR., M.D.
VINCENT E. REYES, JR., M.D. Dr. Reyes is Chief of Hematology & Medical Oncology at St. Clair Hospital. He earned his medical degree at the University of Cincinnati College of Medicine, and completed a residency in internal medicine at Temple University Hospital, Philadelphia. He then completed a fellowship in hematology and oncology at Fox Chase Cancer Center, also in Philadelphia. Dr. Reyes is board-certified by the American Board of Internal Medicine. Dr. Reyes was named a “Best Doctor” in Medical Oncology and Hematology in Pittsburgh Magazine’s 2020 Best Doctors report. Dr. Reyes is the Assistant Medical Director of Medical Oncology at UPMC Hillman Cancer Center and practices with Integrated Cancer Services, which is in-network for all major insurers. To contact Dr. Reyes, please call 412.942.1750.
22 I HouseCall I Volume XII Issue 3
The move to St. Clair’s main campus represents the fulfillment of
nationally recognized patient safety, quality, and patient satisfaction.
a long-held vision for Vincent E. Reyes, Jr., M.D., an assistant medical
And importantly, as part of St. Clair, the new facility is in-network
director at UPMC Hillman Cancer Center who also serves as St. Clair’s
for all major insurers at a great value.”
Chief of Hematology & Medical Oncology. “This beautiful new environment
This collaboration between cancer care teams means that
will enhance our care of patients with cancer tremendously,” Dr. Reyes
patients undergoing radiation oncology and those in need of surgery
says. “It’s both an expansion of our space and of our mission. The new
will have seamless access to medical oncologists like Dr. Reyes
location enables us to bring our cancer team – medical oncologists and
and his colleagues.
radiation oncologists affiliated with UPMC Hillman Cancer Center and
Medical oncology services at Dunlap Family Outpatient Center
St. Clair’s outstanding surgical oncologists and other related specialists
are expected to have a profoundly positive impact on patient
– together on the main St. Clair campus. Being physically closer will
experience, given the building‘s thoughtfully conceived design and
facilitate teamwork and enhance our quality of care.”
numerous amenities. To plan services at the new facility, Dr. Reyes
“It’s the best of both worlds”, says John T. Sullivan, M.D., St. Clair’s
and others on the cancer care team, along with members of the
Senior Vice President and Chief Medical Officer. “The world-class
Hospital’s leadership team, visited model cancer centers across the
expertise of UPMC Hillman Cancer Center, along with St. Clair’s
country. “We toured a variety of cancer centers,” Dr. Reyes recalls. Continued on Page 24
Volume XII Issue 3 I HouseCall I 23
CANCER CARE Continued from Page 23
“The staffs there shared ideas and resources with us, and we were able
private to give our patients personal space and privacy. There are tall
to take away everything that was translatable to our situation. Our goal
windows in every space, so that the sunlight can filter in to the space.
was to create an environment that was patient-focused with access to
You can see trees and sky. Having all that natural light is important;
comprehensive services in a singular location.”
studies have shown that access to light is therapeutic.”
Viewing the experience through the eyes of the patient was the
Dr. Reyes believes patients will feel they have more control in this
touchstone for all design and planning of medical oncology and cancer
environment. “The patients will be able to create a space that works for
treatment, Dr. Reyes says. “We asked ourselves a lot of questions in
them – we want the room to adapt to the patient. They’ll have access
order to understand the patient’s experience. What does the patient
to wifi, individual entertainment units, including TVs, and nutritional
feel? Are there access issues, and do they ever feel intimidated by the
support areas for patients and families. As much as possible, a patient
environment? How does the environment meet their needs and how
will have the same spot each time, so that there are fewer variables. We
does it possibly drain their energy?”
hope that their familiarity with ‘their’ space will lessen the stress they
The new facility will be an extraordinary environment in which to
experience. Some of our patients are there for eight hours, and having
receive care, says Dr. Reyes. “The space is larger than now exists at
the amenities of this environment will make a big difference for them.”
both the Sipe Infusion Center (on St. Clair’s main campus) and my
Although these may seem like minor issues, when one is getting
Village Square office combined. There are 40 infusion chairs; it means
cancer treatment, fatigue is common, mobility may be limited and the
no waiting - you will get your treatment on time. Every infusion chair is
patient may be experiencing difficult side effects. St. Clair’s leadership
The new St. Clair Cancer Center opening this spring will be housed on the top floor of The Dunlap Family Outpatient Center.
24 I HouseCall I Volume XII Issue 3
team, along with the cancer care physicians, recognized this and prioritized efficiency and patient-friendly design. The result is a powerful expression of the Hospital’s commitment to enhancing the patient experience. “People with cancer can be easily overwhelmed with the whole process, so anything we can do that simplifies or streamlines their care is important. The relocation of medical oncology means they have improved access to the care they need,” says Raye J. Budway, M.D., Director, St. Clair Hospital’s Breast Care Center. Dr. Budway expects to have an enhanced sense of community for both patients and physicians with the integration of the comprehensive cancer program – representing medical oncology, radiation oncology and surgical oncology – on one campus. “Moving outpatient oncologic surgery to the Dunlap Family Outpatient Center, along with the infusion services, will allow for a streamlined approach to our patients’ care,” says Dr. Budway. n
Raye J. Budway, M.D.
Architect’s renderings of the medical oncology environment inside the new Dunlap Family Outpatient Center.
RAYE J. BUDWAY, M.D. Dr. Budway specializes in breast surgery and general surgery, and serves as the Director, St. Clair Hospital Breast Care Center. Dr. Budway earned her medical degree at Hahnemann University Medical School, Philadelphia, and completed a residency in general surgery at The Western Pennsylvania Hospital. She then completed a fellowship in surgical critical care at UPMC. She previously served as the Site Program Director for the Allegheny General Hospital General Surgery Residency Program, and Director of the Surgical Breast Disease Program and Surgical Intensive Care at West Penn Hospital. She is board-certified in surgical critical care and general surgery. She is a Fellow of the American College of Surgeons and serves on the Fellowship’s Commission on Cancer. Dr. Budway was named a “Best Doctor” in Surgery in Pittsburgh Magazine’s 2020 Best Doctors report. Dr. Budway practices with St. Clair Medical Services. To contact Dr. Budway, please call 412.942.7850.
Volume XII Issue 3 I HouseCall I 25
DONOR SPOTLIGHT
___ WHY I ___
GIVE Bruce and Barbara Wiegand – Continuing a heritage of philanthropy
G
rowing up in Mt. Lebanon, Bruce Wiegand and his five brothers
1950s. Frank Wiegand, Jr., a former senior general counsel for the United
always played sports – a tradition started by their father, Frank
States Steel Corporation, who died in 1994, was a founding donor of
Wiegand, Jr., a founding donor to St. Clair Hospital. A fine athlete
St. Clair Hospital and served on its original board of trustees. He was also
himself, Frank thought sports were the best way to keep his boys occupied
the driving force behind the Hospital Foundation, established in 1984, and
and out of trouble.
served as its president for many years.
Following his father’s interest in racquet sports, Bruce Wiegand played
In his many leadership roles, Frank made a point of meeting and
for Harvard University’s Eastern Collegiate Championship Tennis Team
talking to the medical staff and doctors. “I think in his heart, he probably
and was also a member of Harvard’s national champion squash team.
wished he would have been a physician,” Mr. Wiegand said. His daughter,
At age 72, Mr. Wiegand still plays tennis three times a week and enjoys
Laura Wiegand, M.D., is an orthopedic surgeon. “I am sure if my father
biking and swimming. He credits physical therapy with helping him recover
were alive, he would be bursting at the seams with pride for her.”
from various sports injuries and to maintain an active lifestyle. His wife,
One of Frank’s proudest achievements was establishing a chapel at
Barbara, also was an avid recreational athlete, playing on Mt. Lebanon’s
St. Clair Hospital, where people can go in times of great sadness, trauma,
tennis and paddle leagues until she was sidelined by a knee replacement.
or joy. He had a strong faith, and he thought the interdenominational
She still enjoys biking, swimming, and most enjoyably, playing with her
chapel would provide great comfort to patients, family members, and staff.
grandchildren. Mr. and Mrs. Wiegand have passed on this emphasis on
Frank, Jr. impressed on his son and his son’s wife the importance of
sports for enjoyment and health to their three children (all of whom were
continuing the family’s support of the Hospital he helped found in 1954.
college athletes) and their eight grandchildren.
Through their own family foundation, Bruce and Barbara Wiegand have
The Wiegands are also continuing Frank, Jr.’s legacy in philanthropy
made a significant donation to St. Clair’s emergency room and have
and athletics by providing the naming gift to the Physical Therapy Suite in
contributed annually to the Hospital for many years. The Wiegands have
St. Clair’s new Dunlap Family Outpatient Center, which is slated to open
personally used the Hospital throughout their lives, not just for physical
adjacent to the Hospital in spring 2021.
therapy, but also for emergency room visits and the birth of one of their
“As an athletic, active family, we need physical therapy and have
granddaughters, Dr. Wiegand’s daughter, Anna.
always benefited from it,” Mrs. Wiegand said. “I think that was part of
“It’s wonderful to have something close to home,” Mrs. Wiegand said.
our motivation for giving to physical therapy. A lot of people who haven’t
“In 10 minutes, I can be there, in the emergency room, be evaluated and
experienced therapy don’t realize how beneficial it can be for their body,
treated, or get referred to physical therapy. It’s nice not to do a 40-minute
for their mind, for their spirits, for their recovery.”
trek across town. I’m not sure everybody realizes that St. Clair is an
Mr. Wiegand agreed. “We’ve both experienced more physical therapy
independent hospital and it’s not funded by some external source. So,
than we’d like due to orthopedic injuries. I think it’s a critical service for a
for anyone who has benefited from St. Clair Hospital, please support it in
hospital like St. Clair.”
whatever way you can.” n
Mr. Wiegand, a retired president, chief executive officer and general
Please consider donating to St. Clair Hospital Foundation. For information
counsel of The Phillips Companies, remembers how dedicated his father
on ways to give, please call 412.942.2465. Thank you. We greatly appreciate
was to establishing a badly needed hospital in the South Hills in the early
your support.
26 I HouseCall I Volume XII Issue 3
ASK THE DOCTOR
Ask the Doctor CAMILLE M. BUONOCORE, M.D.
Q A
Have there been any changes in the way diabetes is treated?
Diabetes mellitus has become more prevalent, in part, due to the increase in obesity in the United States. Diabetes increases the risk of vision loss due to retinopathy, foot infection or amputation, kidney disease, heart attack, and stroke. Improvement in blood glucose control can lessen the risk of diabetic complications. Hypoglycemia is an important limiting factor in the treatment of diabetes. Normal blood glucose levels are approximately 100-180 mg/dl. Hypoglycemia is defined as a finger stick blood glucose of 70mg/dl or less; although 90-100 mg/dl may be more appropriate for people with other chronic illnesses. Severe hypoglycemia is a hypoglycemic event in which an individual’s blood glucose must be restored to normal with carbohydrates and/or glucagon. Hypoglycemia unawareness can occur in people with longstanding diabetes; they fail to recognize the warning symptoms of low blood glucose, and as a result, they are unprepared to prevent severe hypoglycemic events. Finger-stick blood glucose testing is necessary for people treated with insulin or oral medications that can cause hypoglycemia for making decisions about how much medication to take, what to eat or drink, and how active to be. Unfortunately it can be inconvenient, time consuming, and expensive. Real time continuous glucose monitoring (CGM) allows measurement of interstitial fluid glucose every one to five minutes with communication of the glucose level to a reader or smart phone. CGM has been shown to decrease the time spent in hypoglycemia or hyperglycemia and to lower the risk of moderate and severe hypoglycemia. CGM can show glucose trends before and after meals and during and after exercise. It can show glucose levels overnight while sleeping. CGM has been shown to improve blood sugar control and quality of life. There are three companies which offer continuous glucose monitoring devices: Medtronic; DEXCOM; and Freestyle. They are available to Type 1 diabetics, Type 2 diabetics on multiple insulin injections, and Medicare/Medicaid patients when certain criteria are met. They may require finger-stick blood glucose testing to ensure accuracy.
The Tandem and Medtronic insulin pumps deliver insulin continuously through a thin tube inserted under the skin and use CGM devices to stop insulin delivery when hypoglycemia is predicted to occur. CGM devices are also helpful in decreasing hypoglycemia and improving blood glucose control for people using insulin injections before meals and at bedtime. Continuous glucose monitoring has changed the way we approach diabetes management. Our endocrinology practice uses continuous glucose monitoring with and without insulin pumps to improve diabetes control. Our patients have found they help make living with diabetes less of a struggle so they are able to do more of what they enjoy. People interested in continuous glucose monitoring can learn more by talking with their endocrinologists, primary care physicians, or checking the Medtronic, DEXCOM, and Freestyle websites. Editor’s note: This Ask the Doctor column was authored by endocrinologist Camille M. Buonocore, M.D. with input from her associates Bridget Beier, D.O., Douha Safar, M.D., and Monica Gomberg, M.D. n
Camille M. Buonocore, M.D.
CAMILLE M. BUONOCORE, M.D. Dr. Buonocore specializes in endocrinology. She earned her medical degree at State University of New York at Buffalo and completed her internship and residency in internal medicine, as well as a fellowship in endocrinology, at the University of Pittsburgh Medical Center. Dr. Buonocore is board-certified by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C. To contact Dr. Buonocore, please call 412.942.2140. Volume XII Issue 3 I HouseCall I 27
1000 Bower Hill Road Pittsburgh, PA 15243 stclair.org
> To find a doctor, please visit stclair.org General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400
CENTER OF ATTENTION New Dunlap Family Outpatient Center construction nears completion Patients and visitors to St. Clair Hospital’s main campus
One service is the new St. Clair Hospital Cancer Center,
in Mt. Lebanon can’t help but notice that construction of
which will enhance cancer care in a comfortable and
the Hospital’s new Dunlap Family Outpatient Center,
aesthetically pleasing environment. Please see story on
being built adjacent to the Hospital, is getting closer
Page 22 of this issue for more details on the new Cancer Center.
to completion.
Funding for Dunlap Family Outpatient Center is being
The 280,000-square-foot, six-story building is slated to
supported in large part by grants and philanthropy. To
open this spring, bringing a wealth of health care services
donate, please visit: stclair.org/giving/groundbreaking-growth/
and convenience to patients from throughout the region.
HouseCall
is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
@StClairHospital